Effect of Chronic Kidney Diseases on Mortality among Digoxin Users Treated for Non-Valvular Atrial Fibrillation: A Nationwide Register-Based Retrospective Cohort Study

Abstract Background Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection can lead to many different cardiovascular complications, we were interested in studying prognostic markers in patients with atrial fibrillation/flutter (A. Fib/Flutter). Methods A retrospective cohort study of patients with confirmed COVID-19 and either with existing or new onset A. Fib/Flutter who were admitted to our hospital between March 15 and May 20, 2020. Demographic, outcome and laboratory data were extracted from the electronic medical record and compared between survivors and non-survivors. Univariate and multivariate logistic regression were employed to identify the prognostic markers associated with mortality in patients with A. Fib/Flutter Results The total number of confirmed COVID-19 patients during the study period was 350; 37 of them had existing or new onset A. Fib/Flutter. Twenty one (57%) expired, and 16 (43%) were discharged alive. The median age was 72 years old, ranged from 19 to 100 years old. Comorbidities were present in 33 (89%) patients, with hypertension (82%) being the most common, followed by diabetes (46%) and coronary artery disease (30%). New onset of atrial fibrillation was identified in 23 patients (70%), of whom 13 (57%) expired; 29 patients (78%) presented with atrial fibrillation with rapid ventricular response, and 2 patients (5%) with atrial flutter. Mechanical ventilation was required for 8 patients, of whom 6 expired. In univariate analysis, we found a significant difference in baseline ferritin (p=0.04), LDH (p=0.02), neutrophil-lymphocyte ratio (NLR) (p=0.05), neutrophil-monocyte ratio (NMR) (p=0.03) and platelet (p=0.015) between survivors and non-survivors. With multivariable logistic regression analysis, the only value that had an odds of survival was a low NLR (odds ratio 0.74; 95% confidence interval 0.53–0.93). Conclusion This retrospective cohort study of hospitalized patients with COVID-19 demonstrated an association of increase NLR as risk factors for death in COVID-19 patients with A. Fib/Flutter. A high NLR has been associated with increased incidence, severity and risk for stroke in atrial fibrillation patients but to our knowledge, we are first to demonstrate the utilization in mortality predictions in COVID-19 patients with A. Fib/Flutter. Disclosures Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)

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Abstract P609: Restarting Anticoagulant Therapy After Intracranial Hemorrhage With Atrial Fibrillation: A Nationwide Retrospective Cohort Study

Stroke ◽

10.1161/str.52.suppl_1.p609 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Dong Hoon Shin ◽

Jaehun Jung ◽

Gi Hwan Bae

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Lower Risk ◽

Retrospective Cohort ◽

Antiplatelet Agents ◽

Risk Of Death ◽

Hemorrhagic Events ◽

All Cause Mortality ◽

Severe Hemorrhage

Background: Atrial fibrillation (AF) should be treated with anticoagulants to prevent stroke and systemic embolism. Resuming anticoagulation after intracerebral hemorrhage (ICH) poses a clinical conundrum. The absence of evidence-based guidelines to address this issue has led to wide variations in restarting anticoagulation after ICH. This study aimed to evaluate the risks and benefits of anticoagulation therapy on all-cause mortality, severe thromboembolism, and severe hemorrhage and compare the effect of novel direct oral anticoagulants (NOACs) with warfarin on post-ICH mortality in patients with AF. Methods: This retrospective cohort study was performed using health insurance claim data obtained between 2002 and 2017 from individuals with newly developed ICH with comorbid AF. We excluded participants aged < 40 years and those with traumatic ICH, subdural hemorrhage, or subarachnoid hemorrhage. The primary endpoint was all-cause mortality, and the secondary endpoints were severe thrombotic and hemorrhagic events. Anticoagulants, antiplatelet agents, and non-users were analyzed for survival with propensity score matching. Results: Among 6735 participants, 1743 (25.9%) and 1690 (25.1%) used anticoagulants and antiplatelet agents, respectively. Anticoagulant (HR, 0.321; 95% CI, 0.264-0.390; P < 0.0001) or antiplatelet users (HR, 0.393; 95% CI, 0.330-0.468; P < 0.0001) had a lower risk of all-cause mortality than non-users. However, there was no difference between the two drug users (HR, 1.183; 95% CI, 0.94-1.487; P = 0.152; reference: anticoagulant). The risk of acute thrombotic events, although not hemorrhagic events, was significantly lower in anticoagulant users than in antiplatelet users. In addition, anticoagulation between 6 to 8 weeks post-ICH showed a tendency of the lowest risk of death. Further, NOACs were associated with a lower risk of all-cause mortality than warfarin. Conclusions: Our results showed that in patients with AF, resuming anticoagulants between 6 and 8 weeks after ICH improved all-cause mortality, severe thromboembolism, and severe hemorrhage. Further, compared with warfarin, NOAC had additional benefits.

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Effectiveness and Safety of Dabigatran in Atrial Fibrillation Patients with Severe Obesity: a Real-World Retrospective Cohort Study

Journal of General Internal Medicine ◽

10.1007/s11606-021-07114-8 ◽

2021 ◽

Author(s):

Cheng-Wei Huang ◽

Lewei Duan ◽

Jaejin An ◽

John J. Sim ◽

Ming-Sum Lee

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Real World ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Severe Obesity

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Is Concern About Falling Preventing Appropriate Anticoagulation of Elderly Patients With Atrial Fibrillation? A Retrospective Cohort Study

Heart Lung and Circulation ◽

10.1016/j.hlc.2018.06.626 ◽

2018 ◽

Vol 27 ◽

pp. S324-S325

Author(s):

N. Sutherland ◽

A. Vlachadis Castles ◽

L. Monk ◽

W. Van Gaal

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Elderly Patients ◽

Retrospective Cohort Study ◽

Retrospective Cohort

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Cardiovascular and non-cardiovascular hospital admissions associated with atrial fibrillation: a Danish nationwide, retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2012-001800 ◽

2013 ◽

Vol 3 (1) ◽

pp. e001800 ◽

Cited By ~ 10

Author(s):

Christine Benn Christiansen ◽

Jonas Bjerring Olesen ◽

Gunnar Gislason ◽

Morten Lock-Hansen ◽

Christian Torp-Pedersen

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hospital Admissions

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Atrial mechanical hypofunction after electrical cardioversion of persistent or long-lasting persistent atrial fibrillation: a retrospective cohort study

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2019.1178 ◽

2019 ◽

Vol 89 (3) ◽

Author(s):

Renato De Vecchis ◽

Andrea Paccone ◽

Marco Di Maio

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Sinus Rhythm ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Color Doppler ◽

Roc Curves ◽

Persistent Atrial Fibrillation ◽

Electrical Cardioversion

In the present retrospective cohort study, we have evaluated the missed or delayed atrial mechanical recovery in a population of patients with persistent or long-lasting persistent AF who achieved restoration of sinus rhythm on the ECG by electrical cardioversion (ECV). The endpoint of our study was the failure to recover the normal mechanics of the left atrium. Inclusion criterion was the persistent or long-lasting persistent atrial fibrillation successfully treated by means of ECV , provided that a pertinent documentation was made available, comprising ECG, conventional 2D echo-color-Doppler and speckle tracking echocardiography(STE) evaluation, with also a STE assessment of the atria at the days 1, 30 and 90 from the ECV freely available within the clinical record of the patient. Out of a total of 80 patients with persistent or long-standing persistent AF, retrospectively enrolled, as many as 22.5% of them did not achieve the normalization of their atrial STE profile, even though they had been converted to sinus rhythm on the ECG by means of ECV. The building of ROC curves allowed us to establish that early measurements of global atrial strain could serve to predict both the risk of failure to recover the atrial mechanical function and the one of AF relapses over a 12 month follow-up. The values of 18% and 17% were also calculated to serve as cut off values, respectively, for the risk of atrial mechanical dysfunction and for the risk of AF relapses over a 12 month follow-up. Failure to recover the atrial reservoir function can accompany a restoration of sinus rhythm on the ECG in patients with long-standing persistent AF. In this case, a serial STE evaluation could be useful to evaluate the atrial hypofunction over time.

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